Pulmonary mucormycosis in type 1 diabetes mellitus
Published in the journal IDCases, the authors present the unusual case of pulmonary mucormycosis in a 13-year-old Caucasian female that had recently been diagnosed with type 1 diabetes.

The patient was a 13-year-old female that presented to the hospital with complaints of fever, nasal congestion, and worsening cough over four weeks. She was a known case of type 1 diabetes mellitus and was on insulin therapy. An outpatient chest CT had demonstrated pneumonia. Additionally, she developed a brown, purulent sputum and her respiratory function progressively declined.

Chest radiography indicated right lower lobe homogenous opacity suggesting consolidation, and chest CT demonstrated right middle and lower lobe pneumonia. Blood cultures were drawn, and she was empirically started on ceftriaxone and vancomycin.

Overnight, the patient had increased oxygen requirement and was transferred to the pediatric intensive care unit. Infectious disease recommended sputum culture, screenings for pneumococcus and legionellosis, and change antimicrobial regimen to linezolid and meropenem.

During the bronchoscopy, only the larynx was visualized before the patient desaturated, suffered a cardiopulmonary arrest and required immediate resuscitative efforts including CPR, epinephrine, endotracheal intubation, central line placement, and vasopressor support. The patient was subsequently placed on high-flow oscillating ventilator, and the respiratory arrest was believed to be caused by increased secretions and mucus plugging within the airways.

A second bronchoscopy was performed successfully. During the procedure, a large foreign mass was removed from the patient’s trachea. Direct visualization revealed severe tracheitis, fibrosis of the left mainstem bronchus, and lavage was performed in the right lower lobe.

Key takeaway:-
This case serves as an example to healthcare providers treating immunosuppressed patients with pneumonia to have a high clinical suspicion for fungal infections, as delay in diagnosis and treatment can result in disseminated disease and higher patient mortality risk.

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